This is our first resubmission of a randomized trial of QUIT-PRIMO Quality Improvement in Tobacco - Provider Referrals & Internet-delivered Microsystem Optimization in response to PA-06-226 Information Technologies and the Internet in Health Services and Intervention Delivery. Our Overall Goal is to advance science related to the use and impact of the Internet in health services delivery, specifically smoking cessation, by targeting primary care clinical microsystems. A clinical microsystem is defined as the smallest functional healthcare unit. A clinical microsystem is not simply equivalent to a clinical team doctors and nurses, but also includes the panel of patients cared for by the providers and the processes of care that are used. The Institute for Healthcare Improvement (IHI) states interventions targeted to clinical microsystems are a crucial component in improving health care quality. We have the following Specific AIMS: Aim 1. Randomize 160 community- based primary care microsystems into a trial comparing the QUIT-PRIMO with a paper- based information prescription; Aim 2. Evaluate the impact of QUIT-PRIMO on referral rates using patient-reported measures; Aim 3. Evaluate the impact of QUIT- PRIMO on six-month smoking cessation of primary care patients. The QUIT-PRIIMO Intervention is a multi-component Internet-delivered clinical microsystem intervention with: 1. Refer2Quit A point-of-care patient referral portal providers can use to enroll patients into a self-management system, with summary reports of provider and patient activity, and secure messaging templates providers can use to efficiently encourage patients to quit during follow-up; AND 2. Decide2Quit A patient self-management portal organizing interactive, tailored, patient education, cessation planning, links to other high-quality web (smokefree.gov) and offline resources (1-800-QUIT-NOW), and secure messaging patients can use. The Control is a paper-based information prescription providers print to refer patients to a previously developed patient self-management website not linked into the clinical microsystem. The significance of the proposed study is that it will be the first Internet-delivered Intervention targeted to the clinical microsystem with the specific purpose of increasing smoking cessation. Our intervention is also unique among web resources for smoking cessation because a major goal is to enhance follow-up and increase treatment-seeking. QUIT-PRIMO builds upon our previous NCI-funded R21 (Ford, PI), where we our control self-management system for this study. PUBLIC HEALTH RELEVANCE: This is our first resubmission of a randomized trial of QUIT-PRIMO Quality Improvement in Tobacco - Provider Referrals & Internet-delivered Microsystem Optimization in response to PA-06-226 Information Technologies and the Internet in Health Services and Intervention Delivery. Our Overall Goal is to advance science related to the use and impact of the Internet in health services delivery, specifically smoking cessation, by targeting primary care clinical microsystems. The QUIT-PRIIMO Intervention is a multi-component Internet-delivered clinical microsystem intervention with: 1. Refer2Quit A point-of-care patient referral portal providers can use to enroll patients into a self-management system, with summary reports of provider and patient activity, and secure messaging templates providers can use to efficiently encourage patients to quit during follow-up; AND 2. Decide2Quit A patient self-management portal organizing interactive, tailored, patient education, cessation planning, links to other high-quality web (smokefree.gov) and offline resources (1-800-QUIT-NOW), and secure messaging patients can use. [unreadable] [unreadable] [unreadable]